Treatment of thoracolumbar spinal tuberculosis by posterior focus debridement and bone grafting and fixation combined with psoas abscess debridement and local chemotherapy via different approachs / 中国修复重建外科杂志

Objective: To compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach. Methods: Between June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification ( P>0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification. Results: Except that the operation time of group B was significantly longer than that of group A ( t=-2.985, P=0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups ( P>0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal fluid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups ( P0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up ( Z=-2.716, P=0.007). Conclusion: Posterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required.

Preliminary remark on results of emergency surgery fixing thoracolumbar spine combined 2 ways (anterior and posterior ways) in Viet Duc Hospital from January, 2005 to July, 2006

Background: Spinal injury is a severe, common injury in surgical emergency. In Vietnam, there are only few studies on fixing thoracolumbar spine. Objectives: To assess and to provide some preliminary remarks on the results of emergency surgery fixing thoracolumbar spine, performed in Viet Duc Hospital. Subjects and method: A descriptive, prospective study was conducted on 31 patients with thoracolumbar spinal injury (22 males, 9 females, the average age 35 years old), operated in Viet Duc hospital from January, 2005 to July, 2006. Results:Patients with thoracolumbar spinal injury was common seen in working ages. 45.2% of them were farmers. 21/31 patients caused by falls. For non-complete paralysis patients, emergency surgery was required as soon as possible. The most of patients recovered completely. For thoracolumbar spinal injury, Burst-fracture and non complete paralysis, surgery with anterior way should be performed to release cord compression and bone graft. For cases of Burst-fracture, no paralysis, surgery with anterior way helped bone fractures were easy to heal, avoiding postoperative humpback recurrence. Conclusion: Combined surgery with 2 ways (before and after) guaranteed fixing spine, making bone healing was more better in case of rupture of vertebrae, releasing directly spinal cord and facilitating to the best recovery of the spinal cord.

Operation of spinal anterior treat thoracolumbar spinal tuberculosis with paraplegia / 中国矫形外科杂志

[Objective]To evaluate the methods of operation and clinic effective of thoracolumbar spinal tuberculosis with paraplegia.[Method]Thirty cases of thoracolumbac spinal tuberculosis with paraplegia had been treated with primary anterior debridement,decompression of spinal cord,interbody graft bone,and interbody fixation,anti-tuberculosis drug was taken at 18 monthes ofter the operation.[Result]Thirty cases were followed-up for an overage of 19 months and were healed,in which 2 cases recurrence,29 cases spinal fusion of graft bone,12? of kyphosis correction had been gained,the neuropathic fuction had gained improvement excellently(90%).[Conclusion]It had gained good outcome that operation of the primary anterior debridement decompression of spinal cand interbody graft bone and interbody fixation to treat thoracolumbac spinal tuberculosis with pacaplegia.

Relationships between Posterior Ligament Complex Injury and Plain Radiograph in Thoracolumbar Spinal Fracture / 대한척추외과학회지

STUDY DESIGN: A prospective study of 100 patients with thoracolumbar spinal fractures. OBJECTIVES: To assess the relationships between a posterior ligament complex injury and plain radiograph in thoracolumbar spinal fractures. SUMMERY OF LITERATURE REVIEW: Some studies have reported the value of MRI for the evaluation of a posterior ligament complex injury. However, most of these did not evaluate the relationships between the posterior ligament complex and plain radiograph of the thoracolumbar spine fractures. MATERIALS AND METHODS: 100 patients with either a thoracolumbar compression or burst spinal fracture, from T11 to L2 levels, were evaluated by plain radiographs, taken in the supine position, and MRI taken within a week of the trauma. The wedge angle, Cobb's angle and anterior body height were measured on the plain radiographs, and the presence of posterior ligament complex injury on MRI was evaluated and analyzed. RESULTS: In the compression fracture group, the wedge angle, Cobb's angle and anterior body height loss were 19.9+/-1.4 degrees, 14.3+/-2.2 degrees and 35.6+/-3.6%, respectively, in the posterior ligament complex injury subgroup, but only the anterior vertebral body height loss was statistically significant (p=0.04). In the burst fracture group, the wedge angle, Cobb's angle and anterior body height loss were 26.4+/-2.0 degrees, 23.3+/-1.7 degrees and 57.4+/-5.2%, respectively, in the posterior ligament complex injury subgroup, which were all statistically significant (p=0.00, 0.02, 0.00). With a sensitivity of 75% or greater, the wedge angle, Cobb's angle and anterior body height loss in compression and burst fractures were more than 15 degrees, 10 degrees and 30% and 20 degrees, 20 degrees and 40%, respectively. CONCLUSIONS: When the values of wedge angle, Cobb's angle and anterior body height loss in the compression and burst fractures were more than 15 degrees, 10 degrees and 30% and 20 degrees, 20 degrees and 40%, respectively, and the sensitivity for the presence of a posterior ligament complex injury was more than 75%. Therefore, these values in the screening test are indicators for the presence of a posterior ligament complex injury. Further careful evaluations, such as MRI, are still required in deciding the appropriate treatment method.

A Comparative Study of Donor Site Morbidity between Patients with or without Iliac Donor Site Reconstruction after Anterior Thoracolumbar Spinal Fusion using Auto-Iliac Tricortical Strut done Graft / 대한척추외과학회지

STUDY DESIGN: A comparative retrospective study between those who have and have not undergone donor site reconstruction after thoracolumbar spinal anterior interbody fusion using an auto-iliac bone graft. OBJECTIVES: To determine the efficacy of iliac reconstruction in reducing iliac donor site morbidity. SUMMARY OF LITERATURE REVIEW: An autogenous bone graft harvested from the iliac crest is still the gold standard for spinal anterior interbody fusion. However, defects of a significant size often remain in the donor site, which may cause pain, pelvic instability and cosmetic deformity etc. Iliac donor site reconstruction with bone cement is one of the methods for reducing the donor site morbidity, with a relatively easy technique. MATERIALS AND METHODS: A review of patients who underwent iliac bone graft harvesting, with or without reconstruction, by a single orthopaedic surgeon was conducted. The iliac donor site morbidity, at least one after remote surgery was compared in those who had and had not undergone iliac reconstruction. All patients were evaluated by an independent observer. During a two and half year period, 61 patients met the inclusion criteria. Twenty-three patients underwent iliac donor site reconstruction with bone cement and 9 with auto rib bone reconstruction, while the remaining 29 had no donor site reconstruction. Patients were asked to assess the duration and severity of their donor site pain, using a visual analogue scale (VAS), and other morbidity, such as cosmetic deformity. RESULTS: The severity of chronic donor site pain was significantly reduced in the donor site reconstruction group; however, there were no statistically significant differences, other than chronic pain, in the morbidities. CONCLUSIONS: Iliac donor site reconstruction, with bone cement or auto-rib bone, is a relatively easy technique to perform after anterior spinal fusion. Better results can be expected, especially in reducing postoperative donor site pain.

A 6-year Observation of Multiple Spinal Schwannomas Before Excision: 1 Case Report / 대한척추외과학회지

Spinal schwannoma is a slow growing symptomatic tumor which is derived from Schwann cells of peripheral nerves. Most reported cases have been single lesion, while multiple schwannomas have invariably documented one manifestation of von Recklinghausen's disease. Nevertheless, we observed a case of independent, multiple, spinal schwannomas for 6 years before excision. We report the growing velocity and progression of neurologic symptoms and neurologic changes before excision and present a literature review.

Transpedicular Fixation Combined with Mixed Transpedicular Structural and Cancellous Bone Graft for Severe Compressed or Burst Thoracolumbar Spinal Fractures / 中国微创外科杂志

Objective To explore the efficacy of transpedicular fixation combined with mixed transpedicular structural and cancellous bone granule graft for the treatment of severe compressed or burst thoracolumbar spinal fractures.Methods From January 2001 to January 2008,18 cases of severe compressed or burst thoracolumbar spinal fractures was treated with transpedicular fixation of spondylolisthesis and fracture(SF) or atlas fixation(AF) combined with mixed transpedicular structural and cancellous bone granule graft in the compressed vertebral body.Results In this group,no injuries to the spinal cord or nerves occurred.The mean blood loss was 50-300 ml(average 80 ml).The mean operation time was 100-180 min(mean 120 min),and the mean postoperative hospital stay was 12 to 30 days(14 days on average).Follow-up was available in 18 cases for a mean of 24 months(5-72 months),all the patients achieved satisfying recovery of the height and physiological curve of the vertebral body: 17 of the cases had normal height and physiological curve;in the other patient,the natural curve was partly destroyed;no patient had loosing and disrupted internal fixation.According to preoperative Frankel evaluation,1 case was classified as Frankel A,1 Frankel B;5 Frankel C,3 Frankel D,and 8 Frankel E before the operation;while postoperative classification showed 1 case of Frankel B;1 cases of Frankel C,and 16 cases of Frankel E.Conclusions Transpedicular fixation combined with mixed transpedicular structural and cancellous bone granule graft is safe and effective for the treatment of severe compressed or burst thoracolumbar spinal fractures.

Reliability of MRI to Detect Posterior Ligament Complex Injury in Thoracolumbar Spinal Fractures / 대한척추외과학회지

STUDY DESIGN: Prospective study of 34 patients with thoracolumbar spinal fractures. OBJECTIVES: To assess the reliability of MRI in detecting posterior ligament complex(PLC) injury in thoracolumbar spinal fractures. SUMMARY OF LITERATURE REVIEW: Some researchers have studied PLC injury in spinal fracture using MRI. However, most of them did not evaluate the findings of MRI compared to the operative findings. MATERIALS AND METHODS: Thirty-four patients with thoracolumbar spinal fracture were evaluated by palpating the interspinous gap, plain radiography and MRI before operation. These findings were compared with operative findings. In addition to conventional MRI sequences, a fat-suppressed T2-weighted sagittal sequence was performed. Operation was performed by posterior approach. During the operation, we carefully examined the PLC injury. RESULTS: Wide interspinous gap was palpated in 14 patients and was found in 21 patients on plain radiography. PLC injury was suspected in 30 patients on MRI. Injury to supraspinous ligament(SSL) was suspected in 27 patients; interspinous ligament(ISL) in 30 patients; and ligamentum flavum(LF) in 9 patients on MRI. There were 28 SSL injuries, 29 ISL injuries, and 7 LF injuries on operative findings. There was a significant relation between the MRI and operative findings. CONCLUSIONS: A fat-suppressed T2-weighted sagittal sequence of MRI was a highly sensitive, specific, and accurate method of evaluating PLC injury. Based on the results of this study, a fat-suppressed T2-weighted sagittal sequence of MRI is recommended for the accurate evaluation of PLC injury and would be helpful in the selection of treatment options.

Clinical Analysis of Patients with Thoraco-lumbar Spinal Lesions Managed by Vertebrectomy, Interbody Fusion and Stabilization using Kaneda Device

Among the 98 patients who underwent operations for thoracolumbar spinal lesions from May 1989 to September 1994, the authors performed clinical analysis of 72 patients who were followed-up for more than 12 months. There were 52 cases of trauma, 18 cases of tuberculous spondylitis, and 2 cases of metastatic tumor. After partial or toal vertebrectomy, interbody fusion was performed using autogenous iliac bone or autogenous ribs which were taken while approaching the thoracic spine, and stabilized using Kaneda devices. Complete neural decompression was possible under direct vision in all cases. Neurologic deficits improved to an average of 1.7 grades using a modified Frankel scale. Patients with tuberculous spondylitis did not show recurrence or any evidence of increased risk of secondary infection caused by instrumentation. Loosening or breakdown of instruments occurred in 4 patients, and spinal deformity in 7 patients, but reoperation was not needed in any of these patients. By anterior decompression, interbody fusion and stabilization using Kaneda device in thoracolumbar spinal lesions, we could obtain satisfactory neurologic improvement as well as immediate firm stability and high fusion rate involving only a minimum(usually two) number of motion segments as compared with the posterior approach.

Clinical Analysis of Anterior Interbody Fusion Using Kaneda Device in Unstable Thoracolumbar Spinal Lesions(Long Term Follow-up Results)

Recently anterior spinal device(Kaneda device) for the treatment of the unstable spine has been used. We have experienced 33 patients of the unstable thoracolumbar spine, which were composed of 24 cases with burst fracture, 1 case with kyphotic angulation, and 8 patients with tuberculous spondylitis. These 33 patients were treated with and one stage anterior operation consisting of anterior decompression by vertebrectomy and diskectomies, and interbody fusion using autogenous ribs or iliac bone realigment and stabilization with Kaneda device. No patient showed neurologic deterioration after surgery. Follow-up periodes was 6 months to 2.5 years. The anterior spinal instrumentation with Kaneda deviced affored enough stability to enable early ambulation with good aligment and solid fusion.